2. Objectives
Identify unique characteristics of the pediatric airway
Identify upper and lower airway diseases
Distinguish between airway urgencies and
emergencies
3. The Pediatric Airway
Passive flexion due to a large occiput
Relatively large tongue
Mass of adenoidal tissue
U-shaped and floppy epiglottis
Larynx is more anterior
4. The Pediatric Airway
Cricoid ring is the smallest diameter
Narrow tracheal diameter and short distance between
the tracheal rings
Airway cartilage is softer and more flexible
Short tracheal length
Large airways are more narrow
9. Respiratory Status
Bradypnea is more concerning than tachypnea
Normal rate/min
Newborn 30-60
6 months 25-35
1-3 years 20-30
4-6 years 18-26
Adolescent 12-18
10. Signs of Respiratory Distress
Increased work of breathing
Retractions
Nasal flaring
Grunting
Head bobbing
11. Signs of Respiratory Distress
Altered mental status
Agitation
Irritability
Lethargy
Coma
12. Signs of Respiratory Distress
Color
Cyanosis
Pallor
Position
Sniffing position
Tripod position
14. Practical Points
Children have unique airway anatomy
Airway assessment begins with a good history
First impressions give us a lot of information
Signs of respiratory distress
Increased work of breathing
Altered mental status
Color
Position
Auscultation findings
15. Common Pediatric Airway Diseases
Upper Airway Diseases Lower Airway Diseases
Croup
Foreign Body
Epiglottitis
Bacterial tracheitis
Asthma
Bronchiolitis
Pneumonia
Foreign Body
16. Laryngotracheobronchitis
Croup!
Upper airway disease
Viral infection of larynx, trachea and bronchi
Parainfluenza (75%)
Influenza
RSV
Adenovirus
Age 6months-3 years
Male > female
Winter months
18. Clinical Presentation
Gradual onset of URI symptoms (days)
Mild fever, hoarseness, barking cough
Sudden stridor and retractions
Dyspnea and tachypnea
19. Westley Scoring System
0 1 2 3
Stridor None Only with
agitation
Mild at rest Severe at rest
Retraction None Mild Moderate Severe
Air entry Normal Mild decrease Moderate
decrease
Marked
decrease
Color Normal N/A N/A Cyanotic
Level of
consciousness
Normal Restless when
disturbed
Restless when
undisturbed
Lethargic
23. Foreign Body
Basics:
Airway emergency?
The airway is a funnel
Typically under 3 years of age
Impaired mentation
Candy and food
High index of suspicion
27. Epiglottitis
Upper airway disease
Airway emergency
Life threatening bacterial infection of epiglottis and
surrounding structures
Rare
Age 3-7 years
Winter months
Pathophysiology
H. Influenzae
S. Pneumoniae
Group A streptococcus
Staph aureus
31. Bacterial Tracheitis
Rare (0.1 cases per 100,000 children per year)
Invasive exudative bacterial infection of the trachea
Male > Female
Age 3 weeks- 16 years
Pathophysiology
Staph aureus (MRSA)
Strep pyogenes
Strep pneumoniae
Moraxella catarrhalis
H. influenza type B (unvaccinated)
32. Clinical Presentation
Similar to croup
URI prodrome
Fever
Stridor
Barky cough
Hoarseness
Sore throat
No drooling
Respiratory distress
41. Asthma Caveats
Many patients/parents do not take this disease
seriously
Parents may not have an asthma action plan at home
Albuterol is a short acting drug
If patient is requiring multiple albuterol treatments at
home, they should be evaluated immediately
42. Bronchiolitis
Lower airway disease
Airway urgency
2 months- 2 years
Chronically ill are at higher risk
Premature
Congenital heart disease
Less than 1 month old
Inflammation, edema and mucous in the lower
airways
Viral etiology
43. Clinical Presentation
Dyspnea
Tachypnea
Retractions
Nasal flaring
Wheezing
Long expiratory phase
Rales
Rhonchi
Decreased air movement
45. Pneumonia
Lower airway disease
Airway urgency
All ages
Younger patients can be very ill
Chronically ill at higher risk
Bacterial or viral etiology
48. Practical Points
Upper vs. Lower airway diseases- listen for the
diagnosis!
Airway urgencies can quickly progress to airway
emergencies
Beware of the neonate!
Trust the parents
Look for visual cues
Try not to agitate the patient